Pinnock Hilary, McKenzie Lynda, Price David, Sheikh Aziz
Division of Community Health Sciences: GP Section, University of Edinburgh, Edinburgh.
Br J Gen Pract. 2005 Feb;55(511):119-24.
Only about a third of people with asthma attend an annual review. Clinicians need to identify cost-effective ways to improve access and ensure regular review.
To compare the cost-effectiveness of nurse-led telephone with face-to-face asthma reviews.
Cost-effectiveness analysis based on a 3-month randomised controlled trial.
Four general practices in England.
Adults due an asthma review were randomised to telephone or face-to-face consultations. Trial nurses recorded proportion reviewed, duration of consultation, and abortive calls/missed appointments. Data on use of healthcare resources were extracted from GP records. Cost-effectiveness was assessed from the health service perspective; sensitivity analyses were based on proportion reviewed and duration of consultation.
A total of 278 people with asthma were randomised to surgery (n = 141) or telephone (n = 137) review. Onehundred-and-one (74%) of those with asthma in the telephone group were reviewed versus 68 (48%) in the surgery group (P <0.001). Telephone consultations were significantly shorter (mean duration telephone = 11.19 minutes [standard deviation {SD} = 4.79] versus surgery = 21.87 minutes [SD = 6.85], P <0.001). Total respiratory healthcare costs per patient over 3 months were similar (telephone = pounds sterling 64.49 [SD = 73.33] versus surgery = pounds sterling 59.48 [SD = 66.02], P = 0.55). Total costs of providing 101 telephone versus 68 face-to-face asthma reviews were also similar (telephone = pounds sterling 725.84 versus surgery = pounds sterling 755.70), but mean cost per consultation achieved was lower in the telephone arm (telephone = pounds sterling 7.19 [SD = 2.49] versus surgery = pounds sterling 11.11 [SD = 3.50]; mean difference = - pounds sterling 3.92 [95% confidence interval = - pounds sterling 4.84 to pounds sterling 3.01], P <0.001).
Telephone consultations enable a greater proportion of asthma patients to be reviewed at no additional cost to the health service. This mode of delivering care improves access and reduces cost per consultation achieved.
只有约三分之一的哮喘患者接受年度复查。临床医生需要找到具有成本效益的方法来增加复查机会并确保定期复查。
比较由护士主导的电话哮喘复查与面对面哮喘复查的成本效益。
基于为期3个月的随机对照试验的成本效益分析。
英国的四家全科诊所。
应接受哮喘复查的成年人被随机分配接受电话咨询或面对面咨询。参与试验的护士记录复查比例、咨询时长以及未接通电话/错过预约的情况。医疗资源使用数据从全科医生记录中提取。从卫生服务角度评估成本效益；敏感性分析基于复查比例和咨询时长。
共有278名哮喘患者被随机分配接受门诊复查（n = 141）或电话复查（n = 137）。电话组中有101名（74%）哮喘患者接受了复查，而门诊组为68名（48%）（P <0.001）。电话咨询明显更短（电话咨询平均时长 = 11.19分钟[标准差{SD} = 4.79]，门诊咨询平均时长 = 21.87分钟[SD = 6.85]，P <0.001）。每位患者3个月内的呼吸医疗总费用相似（电话咨询 = 64.49英镑[SD = 73.33]，门诊咨询 = 59.48英镑[SD = 66.02]，P = 0.55）。提供101次电话哮喘复查与68次面对面哮喘复查的总成本也相似（电话咨询 = 725.84英镑，门诊咨询 = 755.70英镑），但电话组每次成功咨询的平均成本更低（电话咨询 = 7.19英镑[SD = 2.49]，门诊咨询 = 11.11英镑[SD = 3.50]；平均差值 = -3.92英镑[95%置信区间 = -4.84英镑至3.01英镑]，P <0.001）。
电话咨询能让更大比例的哮喘患者接受复查，且不会给卫生服务带来额外成本。这种护理提供模式增加了复查机会并降低了每次成功咨询的成本。
